MON-602 - Nutritional and Functional Determinants of Long-Term Mortality After Hospitalization in Older Adults: A 9-Year Cohort Study Beyond Type 2 Diabetes

Background: Hospitalization in older adults is a sentinel event associated with sustained functional decline and increased long-term mortality. While type 2 diabetes mellitus (T2DM) is traditionally linked to adverse outcomes, its independent contribution relative to nutritional and functional impairment remains unclear, particularly in cohorts with extended follow-up from middle-income settings.

Objective: To evaluate the relative impact of clinical, nutritional, and functional factors on long-term mortality in hospitalized older adults with and without T2DM.

Methods: We performed a retrospective reanalysis of a prospective cohort including adults aged ≥60 years admitted to medical wards, with follow-up extended up to 9 years after discharge. Data were obtained from electronic medical records, structured interviews, and mortality registries. Nutritional status was assessed using the Mini Nutritional Assessment, and sarcopenia was defined according to adapted EWGSOP2 criteria using muscle strength, physical performance, and calf circumference. In-hospital weight loss and serum albumin were also analyzed. The primary outcome was all-cause mortality. Multivariable Cox proportional hazards models were constructed based on predefined causal frameworks to minimize residual confounding.

Results: Among 588 participants (mean age 73.3±6.5 years; 51% female; 50.3% with T2DM), 391 deaths occurred (66.5%) over follow-up. Independent predictors of mortality included age (HR 1.025; 95% CI 1.010–1.040; p=0.001), malnutrition (HR 1.47; 95% CI 1.10–1.97; p=0.01), hypotension (HR 1.58; 95% CI 1.21–2.07; p=0.001), in-hospital weight loss (HR 1.016 per percentage point; 95% CI 1.006–1.026; p=0.003), and sarcopenia (HR 1.44; 95% CI 1.15–1.80; p=0.001). Serum albumin was inversely associated with mortality (HR 0.77; 95% CI 0.59–0.99; p=0.048). T2DM alone was not independently associated with mortality (p=0.48), whereas the coexistence of T2DM and sarcopenia significantly increased risk (HR 1.61; 95% CI 1.03–2.53; p=0.036).

Conclusions: In this long-term cohort of hospitalized older adults, mortality risk was primarily driven by nutritional and functional impairment rather than by T2DM alone. These findings support a paradigm shift toward systematic assessment of sarcopenia and malnutrition as central, potentially modifiable determinants of prognosis, with implications for risk stratification and targeted post-discharge interventions.

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